Validation of a novel prediction model for early mortality in adult trauma patients in three public university hospitals in urban India

被引：8
作者：
Gerdin M. [1 ]
Roy N. [1 ,2 ,3 ]
Khajanchi M. [4 ]
Kumar V. [5 ,16 ]
Felländer-Tsai L. [6 ]
Petzold M. [7 ,8 ]
Tomson G. [1 ,9 ]
von Schreeb J. [1 ]
Amit G. [10 ]
Ashish J. [10 ]
Debojit B. [11 ]
Deen M.I. [12 ,13 ]
Dusu Y. [10 ]
Jegadeesa K. [13 ]
Jyoti K. [14 ]
Makhan L.S. [11 ,15 ]
Mangesh N. [16 ]
Ranganathan J. [13 ,17 ]
Samarendra N.G. [11 ,18 ]
Sanjeev B. [10 ]
Santosh M. [10 ]
Satish D. [5 ,16 ]
Veera K. [13 ]
机构：
[1] Karolinska Institutet, Health Systems and Policy, Department of Public Health Sciences, Tomtebodavägen 18A, Solna, Stockholm
[2] Bhabha Atomic Research Centre Hospital, Department of Surgery, Mumbai
[3] School of Habitat, Tata Institute of Social Sciences, Mumbai
[4] Seth GS Medical College and King Edward Memorial Hospital, General Surgery, Mumbai
[5] Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
[6] Karolinska Institutet, Department of Clinical Science Intervention and Technology, Division of Orthopedics and Biotechnology, Stockholm
[7] University of Gothenburg, Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg
[8] University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg
[9] Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm
[10] Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi
[11] Institute of Post-Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata
[12] Department of Orthopaedics, Madras Medical College, Chennai
[13] Madras Medical College, Chennai
[14] King Edward Memorial Hospital, Mumbai
[15] Department of Surgery, Institute of Post-Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata
[16] Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai
[17] Department of Neurosurgery, Madras Medical College, Chennai
[18] Department of Neurosurgery, Institute of Post-Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata
来源：
BMC Emergency Medicine | / 16卷 / 1期
关键词：
Early mortality; India; Prediction models; Trauma;
D O I：
10.1186/s12873-016-0079-0
中图分类号：
学科分类号：
摘要：
Background: Trauma is one of the top threats to population health globally. Several prediction models have been developed to supplement clinical judgment in trauma care. Whereas most models have been developed in high-income countries the majority of trauma deaths occur in low- and middle-income countries. Almost 20 % of all global trauma deaths occur in India alone. The aim of this study was to validate a basic clinical prediction model for use in urban Indian university hospitals, and to compare it with existing models for use in early trauma care. Methods: We conducted a prospective cohort study in three hospitals across urban India. The model we aimed to validate included systolic blood pressure and Glasgow coma scale. We compared this model with three additional models, which all have been designed for use in bedside trauma care, and two single variable models based on systolic blood pressure and Glasgow coma scale respectively. The outcome was early mortality, defined as death within 24 h from the time when vital signs were first measured. We compared the models in terms of discrimination, calibration, and potential clinical consequences using decision curve analysis. Multiple imputation was used to handle missing data. Performance measures are reported using their median and inter-quartile range (IQR) across imputed datasets. Results: We analysed 4440 patients, out of which 1629 were used as an updating sample and 2811 as a validation sample. We found no evidence that the basic model that included only systolic blood pressure and Glasgow coma scale had worse discrimination or potential clinical consequences compared to the other models. A model that also included heart had better calibration. For the model with systolic blood pressure and Glasgow coma scale the discrimination in terms of area under the receiver operating characteristics curve was 0.846 (IQR 0.841-0.849). Calibration measured by estimating a calibration slope was 1.183 (IQR 1.168-1.202). Decision curve analysis revealed that using this model could potentially result in 45 fewer unnecessary surveys per 100 patients. Conclusions: A basic clinical prediction model with only two parameters may prove to be a feasible alternative to more complex models in contexts such as the Indian public university hospitals studied here. We present a colour-coded chart to further simplify the decision making in early trauma care. © 2016 Gerdin et al.
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共 32 条
[1]  
Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global burden of disease study 2013, Lancet, 385, 9963, pp. 117-171, (2015)
[2]  
Rehn M., Perel P., Blackhall K., Lossius H.M., Prognostic models for the early care of trauma patients: a systematic review. Scandinavian journal of trauma, resuscitation and, Emerg Med, 19, (2011)
[3]  
Champion H.R., Sacco W.J., Copes W.S., Gann D.S., Gennarelli T.A., Flanagan M.E., A revision of the trauma score, J Trauma, 29, 5, pp. 623-629, (1989)
[4]  
Gormican S.P., CRAMS scale: field triage of trauma victims, Ann Emerg Med, 11, 3, pp. 132-135, (1982)
[5]  
Koehler J.J., Baer L.J., Malafa S.A., Meindertsma M.S., Navitskas N.R., Huizenga J.E., Prehospital Index: a scoring system for field triage of trauma victims, Ann Emerg Med, 15, 2, pp. 178-182, (1986)
[6]  
Husum H., Gilbert M., Wisborg T., Heng Y., Murad M., Respiratory rate as a prehospital triage tool in rural trauma, J Trauma, 55, 3, pp. 466-470, (2003)
[7]  
Perel P., Arango M., Clayton T., Edwards P., Komolafe E., Poccock S., Roberts I., Shakur H., Steyerberg E., Yutthakasemsunt S., Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients, BMJ, 336, 7641, pp. 425-429, (2008)
[8]  
Perel P., Prieto-Merino D., Shakur H., Clayton T., Lecky F., Bouamra O., Russell R., Faulkner M., Steyerberg E.W., Roberts I., Predicting early death in patients with traumatic bleeding: development and validation of prognostic model, BMJ, 345, (2012)
[9]  
Sartorius D., Manach Y., David J.S., Rancurel E., Smail N., Thicoipe M., Wiel E., Ricard-Hibon A., Berthier F., Gueugniaud P.Y., Et al., Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients, Crit Care Med, 38, 3, pp. 831-837, (2010)
[10]  
Kondo Y., Abe T., Kohshi K., Tokuda Y., Cook E.F., Kukita I., Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow coma scale, age, and systolic blood pressure score, Crit Care, 15, 4, (2011)
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